Sunday Republican (Springfield, MA)

May 9, 2004
Section: News
Edition: ALL
Page: A01

Hospital lands top physicians

PATRICIA NORRISSTAFFSunday Republican (Springfield)

Holyoke Medical Center is enhancing facilities and staff but still faces the challenges of a smaller hospital, including funding.

HOLYOKE - When Holyoke Hospital changed its name to Holyoke Medical Center this year, it seemed like semantics.

True, the hospital was remodeling its lobby and building some new operating rooms - but the nicer environment and more modern name could hardly rival the bells and whistles of Baystate Medical Center, the region's only level-one trauma center and teaching hospital.

But then the physicians started coming.

Four prominent professionals - two neurosurgeons, a cardiologist and an endocrinologist - left Baystate in part or altogether to set up shop in Holyoke.

It is a change Baystate officials downplay but one Holyoke administrators seek to capitalize on as they look to increase and keep their patient base while staying afloat in an increasingly difficult financial environment.

"We are not going to do major organ transplants, but we do need to remain very technically competent. We need to recruit highly skilled physicians in the community," Holyoke Chief Executive Officer Hank Porten said about his new employees.

Dr. Loring S. Flint, senior vice president for medical affairs at Baystate, was unconcerned about the physician departures from his sprawling 608-bed medical center in downtown Springfield.

"There is no trend here," he said. "Individuals leave for individual reasons."

The new Holyoke doctors will all be establishing new departments at the hospital and will be performing intricate surgeries - some for the first time there. But the recruitment underscores a business shift for the smaller 202-bed institution.

While Holyoke may not be able to compete head to head with Baystate, it must start offering more services, such as cardiac catheterization, a procedure that was once routinely referred to the tertiary hospital.

Ironically, the improvementscome after a $1 million loss in state funding for the Holyoke hospital and recent layoffs in nonmedical positions.

Porten said reorganizing how and on what he spends his money is crucial to the hospital's survival. Unlike many teaching hospitals, most community hospitals have already exhausted their endowments and have limited options to develop revenue. Teaching hospitals have more income streams available, such as research projects, according to Paul Wingle, spokesman for the Massachusetts Hospital Association.

"I've had to eliminate the things I don't get paid for," said Porten, referring to the lack of financial reimbursement for such things as prevention programs and transportation.

So far none of the new doctors expressed concern about the hospital's financial condition, however.

"Hank was very up front withus on the financial health of the hospital," neurosurgeon Dr. Christopher H. Comey said just before heading off to a spinal fusion surgery - a hospital first. "And we are also working with both Holyoke and Mercy Medical Center to keep costs down."

Comey and his partner, Dr. Kamal Kalia, still maintain operating privileges at Mercy. The two nationally recognized neurosurgeons, who trained at the University of Pittsburgh, will establish a Neurosurgical Center of Excellence in Holyoke, where they will do brain and spinal surgeries. Kalia also donates time at the Shriners Hospital for Children in Springfield.

In addition to staff, Holyoke has designed new operating rooms replete with $120,000 microscopes that will aid the new neurosurgeons.

Porten said he may also seek a residency program with a local medical school or teaching hospital, but he would not disclose details.

A recent Holyoke recruit, endocrinologist Dr. Robert J. Cooper, already runs a biopsy clinic for thyroid tumors that Baystate Medical Center medical students attend. Flint said there have been no formal talks between the institutions, however.

Partnerships between teaching institutions and community hospitals can and have offered the "best of both worlds" to patients, said Wingle. He said such a move would enable Holyoke patients to keep their care local but receive the expert care, advice and technology available at teaching hospitals.

Cooper, an assistant professor of medicine at Tufts University specializing in diabetes and thyroid disorders, including cancer, left his position at Baystate for the Holyoke job.

Dr. Mark N. Porway, a respected cardiologist who worked for nearly two decades at Baystate and left the area to work briefly in New Jersey, will guide Holyoke as it opens its first cardiac catheterization lab.

Porway will continue to do invasive cardiac procedures at Baystate, however. But the lab, scheduled to open in September, is the first step, officials say, in bringing invasive cardiac procedures to Holyoke, a move that must first be approved by the state Department of Public Health.

Diagnostic procedures in the new lab will help physicians learn where heart trouble is occurring and how best to treat the problem.

Wingle said community hospitals such as Holyoke need to focus on offering more services to patients in order to keep them in their care longer.

"It helps to let patients know that not only are you there for their cuts and injuries, you are there when they have potential life-threatening conditions like heart disease," he said. "The strategy Holyoke is pursuing is sound."

But Holyoke is not the first to attempt to branch out into fields usually dominated by mammoth teaching hospitals.

Normand E. Deschene, president and chief executive officer of Lowell General Hospital, began looking toward technology in the 1990s. Lowell General opened a cardiac lab first and will offer angioplasty services to its heart patients this summer.

"I think with community hospitals there is a challenge to get people's perception to change (about the care being offered). There are a number of strategies, and one is to provide good expertise," said Deschene.

The new staff infusion at Holyoke has made most who work there feel "very lucky," said Brenda Loguidice, nurse manager of the hospital's operating rooms. "This really says to people, 'We have good things to offer.'"

Still, a physician leaving Baystate or another teaching institution for a small hospital is thought by some to be the equivalent of leaving the major leagues for the minors. Teaching hospitals, particularly in Massachusetts, enjoy a perceived reputation that care is better than at community hospitals, said Deschene.

"I think that is true for some people. But that is all right with me. I can deal with that," said Porway, who was the former associate director of the cardiac catheterization labs at Baystate. "I have been in institutions like Baystate for the last 18 years, so I have been there and done that. I know what it is like."

For the new doctors, their decisions to join Holyoke Medical are both similar and different. All have been offered the opportunities to build new departments, and each seemed to be granted some level of autonomy they were not afforded at Baystate.

Cooper said the selling point for him was the feeling he was embarking on a new venture with vast potential.

"It is the opportunity here and what we can develop here, for one thing," he said. "We need to focus on what type of things can we provide here to transform Holyoke Medical Center so it will be an institution people choose to come to. That is the goal."

Comey and Kalia say they were attracted by the accessibility to administrators, among other attributes.

"Number one, the bureaucratic complexity at teaching hospitals is not present in smaller hospitals. They are efficient places to work, and there is not a lot of red tape to go through in order to get things out of committee and get things done," said Kalia.

Kalia, who was acting chief of neurosurgery at Baystate, and Comey resigned from Baystate in June. Their departure left the Springfield teaching hospital with only one neurosurgeon until early this year. The break from Baystate was not exactly pleasant for them, they said.

"There are definitely mixed feelings. Leaving Baystate I left a lot of physicians and hospital staff that I really cherished working with," Kalia said. "But on the flip side the administration did not value our services whatsoever . . . and that is where we found opportunity at Holyoke and Mercy."

Baystate's Flint would not discuss personnel matters. But he did say the primary reason the doctors left were due to differing business philosophies.

"I think every one of those individuals has a unique story not for publication," he said.

Comey and Kalia had done the bulk of Baystate neurosurgical coverage, including traumas, since Dr. Munir Abbasy died in 2001. Baystate officials and Comey and Kalia's practice, New England Neurosurgical Associates in Springfield, spent the last three years recruiting other neurosurgeons to the area, but the search was hampered by a national neurosurgeon shortage and a poor practice climate in the state, characterized by low reimbursement rates and high malpractice insurance.

The search was further compromised after Baystate officials decided to build an in-house neurosurgical department, and Kalia and Comey found themselves with competing recruitment interests.

Still, both Comey and Kalia say they are more than ready to leave the past behind them.

"There is a perception in the Baystate community that there is nothing outside of that sphere. I would have to beg to differ on that," said Comey.
(COLOR PHOTOS 1 - Page A14) Dr. Robert J. Cooper

(PHOTO 2) Neurosurgeon Dr. Kamal Kalia, left, and his partner Dr. Christopher H. Comey have joined the staff of Holyoke Medical Center.

(PHOTO 3) Dr. Mark N. Porway

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